Sodium thiosulfate pharmacokinetics in hemodialysis patients and healthy volunteers.

BACKGROUND AND OBJECTIVES: Vascular calcification is a major cause of morbidity and mortality in dialysis patients. Human and animal studies indicate that sodium thiosulfate (STS) may prevent the progression of vascular calcifications. The pharmacokinetics of STS in hemodialysis patients has not been investigated yet. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: STS was given intravenously to 10 hemodialysis patients on- and off-hemodialysis. Additionally, STS was applied to 9 healthy volunteers once intravenously and once orally. Thiosulfate concentrations were measured by using a specific and sensitive HPLC method. RESULTS: In volunteers and patients, mean endogenous thiosulfate baseline concentrations were 5.5 ± 1.82 versus 7.1 ± 2.7 µmol/L. Renal clearance was high in volunteers (1.86 ± 0.45 ml/min per kg) and reflected GFR. Nonrenal clearance was slightly, but not significantly, higher in volunteers (2.25 ± 0.32 ml/min per kg) than in anuric patients (2.04 ± 0.72 ml/min per kg). Hemodialysis clearance of STS was 2.62 ± 1.01 ml/min per kg. On the basis of the nonrenal clearance and the thiosulfate steady-state serum concentrations, a mean endogenous thiosulfate generation rate of 14.6 nmol/min per kg was calculated in patients. After oral application, only 4% of STS was recovered in urine of volunteers, reflecting a low bioavailability of 7.6% (0.8% to 26%). CONCLUSIONS: Given the low and variable bioavailability of oral STS, only intravenous STS should be prescribed today. The biologic relevance of the high hemodialysis clearance for the optimal time point of STS dosing awaits clarification of the mechanisms of action of STS.

Prevalence of three zoonotic Babesia species in Ixodes ricinus (Linné, 1758) nymphs in a suburban forest in Switzerland.

The tick Ixodes ricinus (Linné, 1758) is known as the vector of various Babesia spp. pathogenic for humans. In Switzerland, three of them, Babesia divergens, Babesia venatorum (also known as Babesia EU1), and Babesia microti, have been reported in I. ricinus ticks from various areas. The aim here was to determine how frequently these species infect I. ricinus nymphs in a suburban forest and to determine their prevalence over 3 years along a pathway delimited in four different sections. Babesia spp. was detected and identified in 44/2568 (1.7%) I. ricinus nymphs using Reverse Line Blot. B. venatorum was infecting 1.1% (27/2568) of nymphs, B. divergens 0.2% (4/2568), and B. microti 0.7% (13/1908). Tick infection rates by these three Babesia species between years were not different except for B. microti, which was significantly less frequent in ticks in 2008 than in 2006 and 2007 according to a test using trusted intervals of percentages. B. microti was displaying the greater difference of prevalence among sampling sections, ranging from 1.6% in section 1 to 0% in section 4. The presence of these three Babesia species that are of medical relevance in a suburban forest where I. ricinus tick density is high requires attention from physicians, particularly for patients presenting unspecific symptoms and for patients who are immunocompromised, and who have history of contact with tick biotopes.